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- Title
Preventing Bloodstream Infections and Death in Zambian Neonates: Impact of a Low-cost Infection Control Bundle.
- Authors
Mwananyanda, Lawrence; Pierre, Cassandra; Mwansa, James; Cowden, Carter; Localio, A Russell; Kapasa, Monica L; Machona, Sylvia; Musyani, Chileshe Lukwesa; Chilufya, Moses M; Munanjala, Gertrude; Lyondo, Angela; Bates, Matthew A; Coffin, Susan E; Hamer, Davidson H
- Abstract
Background Sepsis is a leading cause of neonatal mortality in low-resource settings. As facility-based births become more common, the proportion of neonatal deaths due to hospital-onset sepsis has increased. Methods We conducted a prospective cohort study in a neonatal intensive care unit in Zambia where we implemented a multifaceted infection prevention and control (IPC) bundle consisting of IPC training, text message reminders, alcohol hand rub, enhanced environmental cleaning, and weekly bathing of babies ≥1.5 kg with 2% chlorhexidine gluconate. Hospital-associated sepsis, bloodstream infection (BSI), and mortality (>3 days after admission) outcome data were collected for 6 months prior to and 11 months after bundle implementation. Results Most enrolled neonates had a birth weight ≥1.5 kg (2131/2669 [79.8%]). Hospital-associated mortality was lower during the intervention than baseline period (18.0% vs 23.6%, respectively). Total mortality was lower in the intervention than prior periods. Half of enrolled neonates (50.4%) had suspected sepsis; 40.8% of cultures were positive. Most positive blood cultures yielded a pathogen (409/549 [74.5%]), predominantly Klebsiella pneumoniae (289/409 [70.1%]). The monthly rate and incidence density rate of suspected sepsis were lower in the intervention period for all birth weight categories, except babies weighing <1.0 kg. The rate of BSI with pathogen was also lower in the intervention than baseline period. Conclusions A simple IPC bundle can reduce sepsis and death in neonates hospitalized in high-risk, low-resource settings. Further research is needed to validate these findings in similar settings and to identify optimal implementation strategies for improvement and sustainability. Clinical Trials Registration NCT02386592.
- Subjects
ZAMBIA; INFANT mortality; SEPTICEMIA prevention; CHLORHEXIDINE; ALCOHOLS (Chemical class); BATHS; BIRTH weight; BLOOD; CELL culture; PREVENTION of communicable diseases; CROSS infection; ENVIRONMENTAL health; HOSPITAL care of newborn infants; KLEBSIELLA; LONGITUDINAL method; NEONATAL intensive care; SEPSIS; STERILIZATION (Disinfection); TEXT messages; NEONATAL intensive care units; DISEASE incidence; HOSPITAL mortality; CHILDREN; PREVENTION; THERAPEUTICS
- Publication
Clinical Infectious Diseases, 2019, Vol 69, Issue 8, p1360
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciy1114